Christine MacArthur is Professor of Maternal and Child Epidemiology in the School of Health and Population Sciences and lead of the Maternal and Child health research theme in the School. She has published numerous research papers in peer reviewed journals as well as several books and chapters: most of her publications are on this topic. She has received grants from NIHR, MRC, Wellbeing of Women as well as other local, national and international funding bodies. Her main research has been on longer term childbirth related health problems, such as urinary and faecal incontinence and depression, and the evaluation of maternity health services, such as postnatal care. She conducts randomised controlled trials as well as cohort and other epidemiological studies.
Professor of Maternal and Child Epidemiology
PhD Epidemiology 1978
MSc Epidemiology/Public Health 1974
BSc (Hons) Social Sciences 1972
Christine MacArthur obtained a BSc in Social Sciences in 1972. She was then awarded a 2 year ESRC (then SSRC) studentship to study for an MSc by research in the Department of Social and Preventive Medicine, University of Manchester, which she obtained in 1974. Alongside working in the same department as a research associate she obtained a PhD in 1978, which was a trial of anti-smoking education in pregnancy. Following a 3 year period working at Christie Hospital in Manchester on cancer epidemiology she moved to Department of Social Medicine, University of Birmingham in 1981 to work with Professor George Knox. She has stayed as a full-time member of staff since then, first as a research fellow, becoming a senior research fellow, then a Reader in 1995 and in 2000 she was promoted to Professor of Maternal and Child Epidemiology.
Christine is interested in supervising doctoral research students in the following areas:
Trials and other quantitative studies on health problems following childbirth and on evaluation of maternity health services.
If you are interested in studying any of these subject areas please contact Christine on the contact details above, or for any general doctoral research enquiries, please email: firstname.lastname@example.org or call +44 (0)121 414 5005.
For a full list of available Doctoral Research opportunities, please visit our Doctoral Research programme listings
The main emphasis of Professor Christine MacArthur’s research over the last 30 years has been on aspects of women’s childbirth-health. This has comprised generation of hypotheses in large observational studies and investigation of related interventions in randomised controlled trials.
Postnatal urinary and faecal incontinence:
This work, over the last 15 years, is based around a large cohort study (Prolong) with colleagues in Aberdeen and New Zealand. Christine’s earlier work on incontinence was part of a study of health problems up to 9 years after birth among 11701 women based on questionnaires and obstetric case notes. It was published as a book, ‘Health After Childbirth’, by HMSO in 1991. The current cohort study is following an initial group of 7879 women who gave birth in 1993/4 to investigate persistence and risk factors of incontinence and prolapse. It is currently the largest long-tem postpartum cohort study on the topic. The latest paper (BJOG 2011) showed that Caesarean section, relative to vaginal birth is not associated with a reduction in stress incontinence unless all a woman’s deliveries are by Caesarean. And even exclusive Caesarean delivery is not associated with less faecal incontinence: whilst just one forceps delivery will increase the risk. A linked RCT (PINT) of pelvic floor muscle exercise for women with symptoms at 3 months postpartum showed improvement at
1 year but not at 6 years (both BMJ). A current linked RCT (PREVPROL) is on exercise to prevent prolapse, funded in UK centres by RCOG charity Wellbeing. Christine also collaborates on a postpartum cohort study with colleagues at University of Melbourne.
Evaluation of maternity health services
Current research is on lay/peer health workers, an area with little evidence of effectiveness yet widespread service use. As the main focus of the maternity theme of NIHR BBC CLAHRC programme the theme group are conducting an RCT (ELSIPS) to evaluate a pregnancy outreach worker service. The service is provided by Birmingham PCTs to improve birth outcomes in women identified by midwives as having social risk. Recruitment is underway and expected to finish at end of 2011, with follow-up to 3 months after birth.
Breastfeeding services are an area where peer workers are recommended by DoH but with inadequate evidence. A peer support worker service to increase breastfeeding initiation and continuation in Heart of Birmingham PCT was evaluated in a cluster RCT (HoBBIT). The findings showed no benefit of the service in increasing initiation (in BMJ) or continuation to 6 months postpartum. Two systematic reviews by the team further examine evidence on breastfeeding peer support.
Arising from her earlier studies on childbirth-related health, Christine led an RCT of re-designed midwifery-led postnatal care. Care was extended to 28 days postpartum, needs based by systematically identifying health problems and with evidence-based guidelines (produced for midwives by team) to manage these. Findings (Lancet 2001) showed improvement in psychological health and reduction in postnatal depression; these informed the maternity NSF. The guidelines were subsequently published as a book, now in 2nd edition. In the management of postnatal depression a current RCT (PaMPERS) is investigating the effect of exercise in women with diagnosed depression (led by Dr Amanda Daley). A pilot RCT and systematic review showed feasibility of the regime. A parallel RCT is exercise for women with menopausal vasomotor symptoms (Active Women) and a team Cochrane review supports this.
Effects of epidural analgesia
Christine’s work on this arose out of her ‘Health After Childbirth’ study, which indicated a possible increase in certain long-term health problems in women who had epidural pain relief in labour (3 BMJ papers). Epidurals result in more instrumental births and subsequent RCTs examine possible ways to reduce this. An RCT (COMET) in two centres, funded by DoH NHS research programme (Prof Andy Shennan CI of other centre) found low dose mobile techniques resulted in fewer instrumental deliveries than traditional higher dose epidurals. The results (Lancet) have been credited as indicating that the traditional technique is no longer justified in practice. There are still more instrumental births with mobile epidurals than in woman without epidurals and a current NIHR funded trial (BUMPES - led by Prof Peter Brocklehurst) is recruiting 3000 women with epidurals in 5 centres to investigate effects of maternal position in 2nd stage labour. Delivery mode and health effects, including incontinence, will be examined 12 months after birth.
Smoking in pregnancy
Professor Christine MacArthur has undertaken two trials of anti-smoking education in pregnancy: one found a reduction in smoking; the second showed that anti-smoking intervention by midwives and obstetricians was effective in increasing infant birthweight. Funded by an MRC grant, she followed up the study groups when children were aged 9-10 using IQ and neurological soft-sign testing of children, interviews of parents and teachers questionnaires. Findings showed no long-term effects on cognitive development.
Maternal health in developing world
Christine has been involved with studies and systematic reviews of maternal health issues, including reduction of perinatal and maternal mortality and morbidity, also with colleagues in developing world including Pakistan and Africa
Wilson A, Lissauer D, Thangaratinam S, Khan K, MacArthur C, Coomarasamy A. (2011). A comparison of clinical officers with medical doctors on caesarean section outcomes in the developing world: a meta-analysis of controlled studies, British Medical Journal 342:d2600. doi:10.1136/bmj.d2600.
MacArthur C, Glazener C, Lancashire RJ, Herbison P, Wilson D. (2011). Exclusive caesarean section delivery and subsequent urinary and faecal incontinence: a twelve year longitudinal study. BJOG An International Journal of Obstetrics & Gynaecology 118:no.DOI 10.1111/j1471-0528.2011.02964.x.
Brown SJ, Gartland D, Donath S, MacArthur C. (2011). Effects of prolonged second stage, method of birth, timing of caesarean section and other obstetric risk factors on postnatal urinary incontinence: an Australian nulliparous cohort study. BJOG: An International Journal of Obstetrics & Gynaecology 118(8):991-1000.
Ingram L, MacArthur C, Khan KS, Deeks J,Jolly CB. (2010). Does antenatal peer support increase breastfeeding initiation? A systematic review. Canadian Medical Association Journal 182(16):1739-46.
Kelly J, Kohls E, Poovan P, Schiffer R, Redito T, Winter H, MacArthur C. (2010). The role of a maternity waiting area (MWA) in reducing maternal mortality and stillbirths in high-risk women in rural Ethiopia. BJOG: An International Journal of Obstetrics & Gynaecology 117:1377-1383.
Wilson M, MacArthur C, Cooper G, Moore P, Bick D, Shennan A. (2010). Epidural analgesia and breastfeeding: a randomised controlled trial of epidural techniques with and without fentanyl and a non epidural comparison group. Anaesthesia 65(2):145-153.
Freemantle N, Wood J, Griffin C, Gill P, Calvert MJ, Shankar A, Chambers J, MacArthur C. (2009). What factors predict differences in infant and perinatal mortality in Primary Care Trusts in England? A prognostic model. British Medical Journal 339:b2892. DOI:10.1136/bmj.b2892.
MacArthur C, Jolly K, Ingram L, Freemantle N, Dennis C-L, Hamburger R, Brown J, Chambers J, Khan K. (2009). Antenatal peer support workers and breastfeeding initiation: a cluster randomised controlled trial. British Medical Journal 338:b131. DOI:10.1136/bmj.b131.